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This is VAERS ID 273714

Case Details

VAERS ID: 273714 (history)  
Form: Version 1.0  
Age: 0.52  
Gender: Male  
Location: Michigan  
Vaccinated:2007-01-15
Onset:2007-01-25
   Days after vaccination:10
Submitted: 2007-03-02
   Days after onset:36
Entered: 2007-03-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF058AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 3 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Abdominal X-ray, Barium enema, Haematochezia, Intussusception, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic flexure which was sucessfully reduced. BMP unremarkable.
CDC Split Type:

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.


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